From the 11/20/2020 newsletter
Director’s Corner
Thanksgiving is a Time for Gratitude and a Commitment to Making a Difference
By Adina Kalet, MD MPH
Inspired by virtually attending the AAMC meeting this week, Dr. Kalet reflects on how the medical profession is embracing this transformative moment and why, after expressing thanks and gratitude, it’s time to roll up our sleeves up and do the hard and meaningful work ahead …
It is gratefulness that makes the soul great.
-Abraham Joshua Heshel
How do we endure what we witness?
-Anne Curry
- Health disparities are a manifestation of structural racism which we must address to save lives and enhance human dignity and flourishing for us all.
- Without Black and Brown physicians, Black and Brown people will not receive the best medical care.
- There are structural barriers to increasing the number of physicians of color. We must address these immediately.
- The strategies to creating supportive, nurturing academic environments for students of color seeking to become physicians are well known, as Historically Black Universities and Colleges (HBUCs) have educated 50% of all Black physician.
- MCAT scores reflect privilege in access to enriched education, “gap” year experiences, and expensive test preparation. These advantages are not available to all and therefore should not be used to limit access to medical education. European models of access to medical education are instructive here.
- Zero sum thinking is keeping us from recognizing that investment in diversifying our profession will “float all boats.” Power is not a scarce resource; it is unlimited.
- For our culture to “bend toward justice,” we must all be actively engaged.
- Acknowledge the reality of privilege and its impact on maintaining white and wealth supremacy
- Seek expertise outside of the walls of the profession to help us address these issues Bring our students to the table and listen to them
- Communicate often and with authenticity and sincerity
- “Get proximate” to the people we hope to serve and seek to see people as individuals with basic humanity
- Set audacious goals for change and get and maintain accurate data to guide change toward those goals
Thanksgiving 2020 will be unprecedented. Traditionally, Americans mark Thanksgiving with deep family connections, too much food, football, and moments of gratitude. This year, though, hospitals will be overwhelmed, and health care professionals will be working harder and under harsher circumstances than ever before. We will all be socially isolated. The adjustments will be difficult and promise to worsen. Because our residents are working incredibly hard, we want them to know how grateful we are for them. In collaboration with MCWAH, the Kern Institute will be providing “to-go” meals for our trainees on Thanksgiving. Oh, and we will be providing those amazing Kern Cookies, as well.
There are many things for which we are grateful. In my family, we will replace the usual West Coast trip to see the in-laws with Zoom games and remote pie baking lessons. I am grateful for the opportunity to avoid airports on Thanksgiving! I might even start my “gratitude journal” because positive emotion is important when the days get short and cold. Expressing gratitude is associated with personal happiness and is, in part, necessary to create human flourishing (eudemonia in Greek), which Aristotle, philosophers, theologians, and psychologists considered the ultimate goal of a good life and a healthy society.
I have also been grateful for and astonished by this week’s virtual Association of American Medical Colleges (AAMC) annual meeting, the largest gathering of medical educators in the world. Over the years, I had become disappointed by the diffuse and frankly self-absorbed nature of the meeting. But in this special year, under the leadership of President David Skorton and Chairman of the Board, our own Joseph Kerschner, the AAMC has found its soul! When needed more than any other time in history, there is a movement afoot for a powerful transformation in American medical education.
AAMC addresses COVID-19 and structural racism
Compared with the usual AAMC meeting – thousands of medical educators from around the world in enormous, Jumbotron-enhanced ballrooms listening to leaders and topflight “inspirational” speakers – the virtual version is intimate and stirring. I sit in my living room while “Rock Stars” NIH Director Francis Collins, NIAID Director Anthony Fauci, and CDC Principal Deputy Director Anne Schuchat remind us that COVID-19 is far from over. The pandemic is terrible and getting worse. Thankfully, effective treatments are emerging and effective vaccines are in sight. I am grateful that there are world-class scientists and thought leaders at the helm, collecting valid data and communicating simply and honestly. I am grateful to be reminded that our role right now is to be trustworthy, courageous, risk taking leaders.
Thankfully, AAMC also provided us with a conference chock-full of the “Rock Stars” of the national conscience. Journalists Nikole Hannah-Jones and Ann Curry, educators and historians Ibram X. Kendi and Secretary of the Smithsonian Institute Lonnie Bunch, III, each in her or his own way challenged us to face reality head on and then act, every day in every way, to make concrete changes.
But what to do to create change? Where do we engage?
If we think of racism as Stage 4 cancer, we would know what to do
When educator and historian Ibram X. Kendi, was 37-years-old and writing his now iconic book, How to be an Antiracist(MCW’s Common Read this year), he was diagnosed with and battling Stage 4, widely metastatic colon cancer.
Kendi is not only a national intellectual treasure, but a human face of race-based health disparities. Black Americans are 20% more likely to be diagnosed with cancer. Luckily, he is now disease-free, unlike Black Panther actor Chadwick Boseman, who died at 43 in August 2020 of the same disease. When compared to whites, Black men have a 40% higher death rate from this disease. Professor Kendi formulated the compelling analogy that racism in America is a Stage 4 metastatic cancer, sapping us of our vitality, threatening our lives, and stealing from us the future contributions of our greatest intellectuals and artists. But here is the silver lining: By widely sharing the particulars of his personal story, as well as his life’s work, Kendi allows us to imagine routing racism out of society for good.
We in medicine know how to attack an aggressive disease, how to throw everything we have at it, to declare war on it. We know we must serve up the full commitment of intellectual, scientific, spiritual, and financial resources to prolong life and enhance quality of life while we search for a cure. This is important work, worth engaging in.
But the cancer analogy doesn’t stop there. Kendi also provides guidance on how to create the “good life.” In an essay in The Atlantic, Kendi describes how the act of writing his book literally reduced his suffering and allowed him to put the physical and existential drama of his cancer battle in perspective. Work created a profound experience of well-being even during severe stress. This deep engagement with the act of work, what psychologist Mihaly Csikszentmihalyi calls “flow,” is a characteristic of “optimal” performance and profound well-being. In medicine, when we have such experiences, our work is purposeful and meaningful.
Back to the AAMC
The meeting has been loaded with meaningful and important moments. Among the realities and takeaways:
To make concrete, corrective, and transformative changes in medical education, we must:
Gratitude and commitment
I am now committed to a few, specific actions. This year, we must address equity in the medical school admissions process and we must redouble our efforts to transform the curriculum to both prepare future physicians for the challenges ahead and address the profound challenges to the well-being among our own. This will be hard work and we must face the realities and roadblocks head-on. If, we take on these challenges – in community – we will be rewarded with a sense of pride and thanksgiving for our courage to engage, take risks, and accomplish things that matter.
Many among us are profoundly fatigued from the pandemic and hope to feel a whisper of relief at this time of Thanksgiving. Let us take this time to be grateful for what we do have and for each other. Give thanks for and support to our colleagues who are engaged in the hard, hard work of patient care these days. Be grateful for the opportunities we have to change the future of medical education.
Gratitude – and the opportunity to do meaningful, healing, and important work – is good for us all. Happy Thanksgiving.
Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin
